Provider Demographics
NPI:1104165067
Name:BARNES, MARY GERTRUDE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:GERTRUDE
Last Name:BARNES
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:OK
Mailing Address - Zip Code:73651-1615
Mailing Address - Country:US
Mailing Address - Phone:580-726-5088
Mailing Address - Fax:
Practice Address - Street 1:429 W ELM ST
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:OK
Practice Address - Zip Code:73651-1615
Practice Address - Country:US
Practice Address - Phone:580-726-5088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0064303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200478250AMedicaid
OKR0064303OtherOKLAHOMA BOARD OF NURSING